In October 2014, Drug Strategies presented Tunnel Tail: A New Approach to Prevention at the 2014 Games for Health Europe Conference. See the paper below: 

Tunnel Tail: A New Approach to Prevention

Mathea Falco, Jesse Schell, and Deidre Witan

Abstract. This study determined the efficacy of the game Tunnel Tail in improving players’ confidence in their ability to resist illegal drugs and alcohol. 246 students in the target age group of 11 to 13 years old were given a survey before and after playing Tunnel Tail. Players were split into two groups, which played either one or two twenty-minute sessions. Session length was based on data of average play time. Comparing survey responses before and after gameplay, 86% of active players showed improvement in at least one area of resistance attitudes. Players who reported reading and paying attention to the in-game dialogue showed greater improvement. Additionally, longer play time was correlated with increased confidence in resistance behaviors. Despite its limitations (small sample, lack of control group), the survey suggests that a larger study is warranted. Tunnel Tail provides an early glimpse of the potential for using sophisticated game apps to enhance learning of resistance skills and effect behavior change.
Keywords: adolescent substance abuse prevention, resistance skills, efficacy survey, mobile game app, drug use prevention

1. Introduction

Adolescent smoking, drinking, and drug use remain a major concern in the United States. The most recent National Survey on Drug Use and Health estimated that 2.4 million children ages 12–17 were current drug users, meaning that they had used illicit drugs in the past month before the survey [1]. Experimentation with substances begins early in life: among 8th graders, 19% reported having tried an illicit drug in 2012, while 15% reported having used tobacco and 30% had drunk alcohol [2].

In order for drug prevention efforts to be effective, they must target youth at the age at which they begin experimenting with substances [3]. This is important in light of the fact that the research shows that the earlier young people start to use substances, the more likely they are to experience adverse outcomes [4]. For the past three decades, school-based drug education curricula, supported by billions of dollars in federal government funding, have been the primary approach to prevention. However, many of these programs have not been rigorously evaluated, and those that have often fail to show overall reductions in drug use. Moreover, effects of even the best programs fade unless booster sessions are provided in high school [5]. At the same time, schools have come under increasing pressure from academic testing requirements, and severe budget cuts have reduced teaching staff and classroom hours.  As a result, drug prevention in most public schools has largely disappeared or been reduced to a few sessions in middle school.  New approaches to drug education and prevention are urgently needed.

Tunnel Tail is a major innovation in the prevention field: a highly engaging, complex mobile game built on important prevention concepts and designed to reach adolescents ages 11–13 outside the classroom by bringing prevention messages directly to them on their mobile devices, where they spend much of their time.

The primary purpose of this survey was to determine if the game was effective in changing attitudes surrounding drug use, specifically players’ confidence in resisting pressure to use drugs and their motivation to do so. If Tunnel Tail shows positive effects in improving resistance skills among young adolescent players, it could point the way to a new generation of sophisticated prevention game apps to enhance learning of resistance skills and possibly effect behavior change.


2. Methods

Tunnel Tail, an award-winning free game app built on key prevention concepts, is designed to reach youth where they spend many of their waking hours: communicating and playing games on hand-held devices [6].  Developed for the BEST Foundation by Schell Games in consultation with Drug Strategies, Tunnel Tail targets adolescents 11-13 years old, when they begin experimenting with alcohol, tobacco and drugs [3].  Early focus testing found that this age group reacts very negatively to direct reference to anything resembling formal “drug education.” Consequently, the game mechanics and dialogue use metaphors that build on key prevention concepts embedded in the text and game play, rather than on more direct didactic formats that often characterize traditional classroom-based prevention curricula.  Specifically, the game is designed to introduce players to situations where they may feel pressures to use substances and how to deal with those situations, to show that players don’t need to give in to pressures to be cool, to engage players in positive peer support, and to provide different scenarios for trying out resistance skills. Players practice those resistance skills through repetitive game play that encourages incidental learning as they advance through the game.  While the design and conceptual framework of the game app is built on key findings of prevention research of the past two decades, [7,8] Tunnel Tail takes an entirely new approach to prevention messaging.

Tunnel Tail is a sophisticated role-playing game with complex graphics and player interactions built for iPhone and Android platforms. The main characters are intelligent mice who live with humans in real world settings and must confront the Controllers, who are trying to take over their world. The mice, despite their size, can become powerful when they stand up for themselves, take control of the situation and help other mice. The core element of the combat system is the pressure mechanic that displays different levels of pressure depending on the scenario and provides different methods for players to respond. Players level up with each effective response to pressure situations. Through its multiplayer features, the game emphasizes relationships, leadership, confidence and learning to take control. Although playing through the entire game takes about ten hours, most kids play intermittently; they may leave the game for several weeks and then return. Everything is saved, so they can continue playing where they left off.

Extensive focus group testing with the target adolescent age group influenced the graphics, design and game play.  Engaging both girls and boys was an important priority. For example, the game uses turn-based play, rather than aim-and -shoot fights, because they proved to be popular with both boys and girls. Players can also customize their mice with different outfits and equipment, an option especially attractive to girls, while the toughness of the mouse characters appealed particularly to boys.

Tunnel Tail was launched as a free app in September, 2012; by June, 2013, there had been 255,000 downloads. Of this group, 40 percent are active players. Tunnel Tail is highly rated both on Google Play (4.2 stars) and iTunes (4 stars). The app was a finalist at the 2012 Serious Games Challenge, runner-up for overall best digital game at Meaningful Play 2012, and won a Silver Medal at the 2013 International Serious Play Award.


3. Design 

This study employed a two group pre-post design. Participants were randomly assigned to the two groups. Respondents were divided into segments based on gameplay assignment and gender:

  • Short-Play Respondents (n=109): played Tunnel Tail once for 20 minutes.
  • Long-Play Respondents (n=137): played Tunnel Tail twice for 20 minutes each, with a break of at least 4 hours in between.
  • Males (n=155)
  • Females (n=91)

A set of questions addressing the game’s appeal, memorable aspects, and core messages was given before and after gameplay to assess changes in answers between pre- and post-gameplay.


4. Participants

246 male and female gamers, ages 11 to 13, participated in the study. Within the target audience, all respondents regularly played other games on mobile devices (iOS/Android phones or tablets).  VGMarket, a market research firm specializing in the videogame industry, conducted an online survey in May 2013. Using online and phone screening, 246 eligible subjects were recruited from VGMarket’s database of over 250,000 video game players. (Funding limitations for the study capped the number of participants at 250.)  Subjects were screened for age, gender distribution, and familiarity with other mobile games. Because the survey was conducted online, subjects were located in at least 18 different states, however, 30.5% did not disclose their address. Informed verbal consent was obtained both from parents of the adolescents and the adolescents who participated in the online survey. The questions were developed at the Harvard Graduate School of Education’s Technology, Innovation and Education Program in consultation with Drug Strategies.


5. Procedures

Players were divided into a “short-play” group (20 minutes) and a “long play” group (two 20 minute sessions separated by at least four hours).  This format of 1 or 2 20-minute sessions was based on the average gameplay time, based on the statistics provided by Schell Games. According to their metrics, 72.1% of active players play at least 2 battles, which is easily achieved within the first 20 minutes of the game. This means that the results from the short-play group are directly applicable to at least 72.1% of active players. Additionally, 28.4% of active players obtain a second mouse, which occurs after about 40 minutes of total gameplay. By testing players at 20 and 40 minutes, we were able to get a good assessment of the majority of players. Furthermore, Schell Games designed Tunnel Tail to be played casually in short spurts, so having the long-play group log out of the online survey between their 20-minute play sessions fit with the overall design for the game.


6. Data Analysis

6.1 Comparison of Pre- and Post-Gameplay Questions 

Players were asked similar questions before and after gameplay about their perceived abilities to recognize and resist peer pressure. The vast majority of players exhibited changes in their answers between these pre- and post-gameplay questions. These changes did not all reflect an improvement in peer resistance confidence and attitudes, but 86% of the respondents did exhibit at least one positive (reflecting improvement) change in their responses after playing the game.

In addition, players were asked what they were paying attention to and what they remembered after they had finished playing.  There was a statistically significant correlation between players who indicated that they did remember the dialogue and those who exhibited positive changes between pre- and post-gameplay answers (P<0.001).

Additionally, students who reported reading the in-game dialogue also exhibited a significantly higher number of positive changes (P=0.043).  Conversely, there was also a correlation between the students who indicated that they did not read the in-game dialogue and the number of negative changes they exhibited in pre- and post-gameplay questions (P=0.035). This indicates that the in-game dialogue is crucial to the game’s success as a prevention tool.


6.2 Comparison of Short- and Long-play Groups 

Longer play time was significantly correlated with a higher confidence in ability to leave a situation where drugs and/or alcohol are being used. One question measured players’ confidence in their abilities to avoid and refuse illegal drugs by asking for their confidence level on five different resistance behaviors.  There was a statistically significant correlation between play time length and the level of confidence in their ability to leave a pressuring situation (P=0.025).

Additionally, a higher percentage of players identified a key message of the game in the long-play group. The percent of players who identified If you practice standing up for yourself, your skills will improve as a core message of the game increased from 70.6% of the short-play group to 81% of the long-play group. This is strong evidence of the positive effects of increased gameplay time (P=0.057).


6.3 Evidence of Appeal

When asked, “Would you keep playing the game past the point where you were asked to stop?” 33.7% of students reported that they “definitely would” continue playing the game, which was a higher percentage than any other answer. Among boys, 39% of those in the long-play group reported that they “definitely would” continue playing the game, as opposed to 23% in the short-play group.  There was a statistically significant correlation between players’ answers to this question and whether or not they read the in-game dialogue (P<0.001), however, it is unclear if reading the dialogue helped players enjoy the game more, or if enjoyment of the game helped players remember the dialogue.

In addition, 77% of the students would have chosen to play for longer than their allotted time. 80% of the long-play group, as compared to 73% of the short-play group, reported that they would like to continue playing, which indicates strong replay value.

When asked to what words accurately describe the game, only 4% chose “educational.” The most popular responses were “interesting” (59%), “fun” (47%), and “addictive (34%).[1]  There was a statistically significant correlation between the long-play group and those who characterized the game as “educational” (P=0.026), which indicates that the longer a player is exposed to the game, the more likely they are to see the intentional educational messages.


7. Discussion

Tunnel Tail’s purpose was to model resistance strategies in order to help players identify pressuring situations and practice healthy responses. The evidence suggests that playing Tunnel Tail helped students practice resistance skills as well as increase their confidence in their abilities to resist peer pressure to use drugs. A majority of players showed improvement between pre- and post-gameplay questions, and those improvements were correlated with reading and remembering the in-game dialogue. In addition, longer game play was significantly correlated with higher confidence in a players’ ability to leave a situation where drugs and/or alcohol are being used.

The implications of these results are limited by the survey’s small sample size, the lack of a control group, and the limitations of attempting to measure true behavior change through a written survey. In addition, the fact that both negative and positive changes in answer choices between pre- and post-gameplay questions were exhibited lowers the significance of any inferences that can be made.

Table 1a (Survey Responses Before Gameplay)

How much do you agree/disagree with these statements?Completely agreeMostly agreeMostly disagreeCompletely disagree
I am very social and like meeting new people46%43%9%3%
I can’t always tell when someone is trying to manipulate me5%28%48%20%
I have no idea what to say when a friend disagrees with me3%11%53%33%
I often think things through and plan ahead28%53%17%2%

I often let other people get their way to avoid a conflict3%37%43%16%
I often play multiplayer video games43%37%15%4%
Doing what I want is more important to me than fitting in24%56%16%4%
I can easily express my emotions30%51%17%2%
I stand up for myself when my friends and I disagree37%55%7%1%
Sometimes I need time to be alone31%50%12%7%
It’s not important for friends to like the same things18%52%24%5%
I will do something I think is too risky if my friends encourage me3%17%47%33%

Table 1b (Survey Responses After Gameplay)

Would you keep playing the game past the point where you were asked to stop?Definitely31%
Probably would26%
Maybe would20%
Probably wouldn’t13%
Definitely wouldn’t3%
I would have stopped earlier8%
What words accurately describe this game? (Choose all that apply)Interesting59%
Compared to other free mobile phone games you’ve played, how much fun was Tunnel Tail?No fun at all14%
It was fun, but most other games are more fun24%
More fun than a few other games17%
About as much fun as other games16%
More fun than a lot of other games17%
More fun than most other games9%
The most fun mobile game I’ve played3%
The mice sometimes talk to you and each other outside of battle. What did you think? (Choose as many as apply)It helped me understand what was going on52%
I enjoyed finding out more about the story36%
Too many dialogue screens28%
I got impatient to get to the next mission or battle28%
I often clicked through the screens without reading them28%
It helped me get to know the characters26%
I would have liked to learn more about the characters and story20%
Too much text on each screen17%
I don’t remember what the mice said16%
During battle, the mice make comments to each other. What were the most memorable comments? (Does not have to be exact)Respondents filled in a text box with their answers

Table 1c (Survey Responses After Gameplay, cont'd.)

What are some ways that the ideas in Tunnel Tail can address real-life problems?Expressed in the game (%Yes)Helpful in real life (%Yes)% Yes to both
Mice sometimes fight with each other93%27%N/A
It’s easier to stand firm when you have the support of your friends74%93%69%
Working hard now will lead to rewards later on76%93%N/A
It’s best to stick to your own territory54%43%N/A
Paying attention to the tension level helps in conflict89%69%63%
Better equipment makes it easier to win85%61%N/A
If you practice standing up for yourself, your skills will improve80%92%76%
Sometimes enemies will say nice things to try win you over90%79%73%
You should treat others the way you’d like to be treated48%93%N/A

Table 1d (Survey Responses After Gameplay (cont'd.)

A friend of yours is pushing you to do something you don’t want to. How likely are you to respond in each of these ways?Definitely wouldProbably wouldMaybe wouldProbably wouldn’tDefinitely wouldn’t
Give it a try—you might enjoy it4%17%41%18%20%
Do what he wants to do now, and then do something you like later6%17%27%27%22%
Provide an alternate suggestion22%45%27%4%3%
Say that maybe you’ll do it later6%23%34%19%18%
Change the subject to talk about something else15%36%31%12%7%
Make fun of her for wanting to do it1%6%9%32%53%
Firmly say no and stick to it30%26%29%11%4%
Get a friend to back you up11%30%39%14%7%
Walk away12%22%26%24%16%

Table 1e (Survey Responses After Gameplay, cont'd.)

How much do you think people risk harming themselves (physically and in other ways) if they…No riskModerate riskGreat risk
Smoke one or more packs of cigarettes a day2%8%90%
Skip class14%50%36%
Ride in a car42%54%4%
Ride in a car without wearing a seat belt4%38%58%
Try an illegal drug once3%28%69%
Regularly use illegal drugs3%4%93%
Fly in an airplane42%52%6%
Parachute out of an airplane7%53%40%
Get drunk4%24%72%
Ride a motorcycle without a helmet2%21%77%

Table 1f (Survey Responses After Gameplay, cont'd.)

People differ in whether or not they disapprove of people doing certain things. How much do you disapprove of people doing each of the following?ApproveDisapproveStrongly disapprove
Smoke one or more packs of cigarettes a day2%13%85%
Skip class6%46%48%
Ride in a car95%3%2%
Ride in a car without wearing a seat belt5%46%49%
Try an illegal drug once4%24%73%
Regularly use illegal drugs2%6%92%
Fly in an airplane90%5%4%
Parachute out of an airplane49%37%14%
Get drunk5%26%68%
Ride a motorcycle without a helmet5%26%69%

Table 1g (Survey Responses After Gameplay, cont'd.)

How sure are you on each of these questions?Not at all sureModerately unsureModerately sureCompletely sure
Can you refuse an offer of alcohol or illegal drugs?2%2%13%84%
Can you think of a way to stop someone who is pressuring you to drink or do drugs without making them angry?3%9%48%40%
Can you avoid situations where you know other people will be drinking or doing drugs?2%6%27%65%
Can you think of a way to leave a party where people are drinking or using drugs—without being made fun of?2%8%31%59%
Can you say “no” in a serious way and stick to it when a friend is pressuring you to drink or use drugs?1%3%20%76%

Table 1h (Survey Responses After Gameplay, cont'd.)

How much do you agree/disagree with these statements?Completely agreeMostly agreeMostly disagreeCompletely disagree
I know what to say when a friend disagrees with me32%50%13%4%
I don’t always stand up for myself when my friends and I disagree6%18%43%33%
It’s important for friends to like the same things7%37%36%20%
I won’t do something I think is too risky even if my friends encourage me46%39%11%4%
I don’t let other people get their way to avoid a conflict16%40%35%9%
Fitting in is more important to me than doing what I want to do3%12%48%37%
I can always tell when someone is trying to manipulate me31%49%15%5%

Table 2 (Short- and Long-Play Group Procedures)

Short-Play GroupLong-Play Group
Pre-gameplay questionPre-gameplay question
One 20-minute play sessionOne 20-minute play session
Immediately take surveyWait at least 4 hours (no activities specified for this period)
Second 20-minute play session
Survey Questions 1-10Survey Questions 1-10
Post-gameplay questionPost-gameplay question

Table 3. Answers to the question, “Can you think of a way to leave a party where people are drinking or using drugs—without being made fun of?”

 Short PlayLong Play
Completely sure49.54%66.42%
Moderately sure37.61%26.28%
Moderately unsure12.84%7.30%


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[1]    Respondents could choose more than one answer
[2]    Included pictures of the referenced aspects of the game
[3]    The response of “completely unsure” has been omitted from this table for clarity, as no respondent chose that answer.